Recognizing periodic alternating nystagmus

Congenital or acquired periodic alternating nystagmus (PAN) is characterized by nystagmus occurring in a cycle. The cycle consists of a left-beating nystagmus, a transition phase, a right-beating nystagmus, and a further transition phase. The purpose of this review is to assist the clinician in the recognition of periodic alternating nystagmus (PAN), either as a type of congenital nystagmus or in its acquired form, and to highlight why such identification is important. Recent studies using eye movement recordings are reviewed to point out the frequency of congenital PAN in samples of patients with congenital nystagmus, and to describe the characteristics of the waveforms and the influence of foveation time on the alternation of head turns. Classical and new surgical alternatives are reported. The identification of congenital PAN is essential when surgical treatment is being considered for the correction of anomalous head postures. Acquired PAN is usually due to cerebellar disease and causes oscillopsia. Unlike other forms of acquired nystagmus, it responds well to drug treatment.